| NPI | 1578376919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 188216) |
| 163W00000X Registered Nurse (Licence: TX 910997) | |
| Enumeration Date | 2025-01-29 |
| Last Update Date | 2025-01-29 |